Communication for Medical Advices between Prehospital Providers and Physician Medical Directors

PURPOSE: On-line medical control, in addition to indirect control like protocols, is known to exert a positive effect on the quality of prehospital care. Because the decision-making process of directing physicians depends on the information provided by prehospital providers via telecommunication, brief and organized reporting of significant points is of paramount importance. METHODS: Telecommunications regarding direct medical control provided by emergency physicians in a university hospital were recorded from May 1 to June 30, 2012. All communications were between cellular phones. Analysis of the recorded dialogues was performed by an independent researcher. RESULTS: A total of 115 cases were included for analyses. Affiliated fire offices were reported in 107 (93.0%) cases, while certification of responding officers was reported in only 62 (53.9%) cases. All five vital signs were reported in only 9 cases (7.8%), including blood pressure, heart rate, respiration rate, temperature, and oxygen saturation. Procedures delivered before telephone contact were reported in 30.4% of cases, and reporting rate of patient response to treatment was 16.5%. Estimated times of arrival to the destined hospital were reported in only 8.7%. CONCLUSION: Reporting procedures regarding prehospital direct medical control should be concise and comprehensive, including essential elements like certification of the provider, consciousness and vital signs of the patient, and estimated time of hospital arrival.

Clinical Analysis of Outpatient Treatment for a Spontaneous Pneumothorax

PURPOSE: In the Emergency Department, inpatient and invasive treatment of pneumothorax patients have been causing overcrowding and higher medical costs, both of which are considered to be an important factors that affect adversely the clinical activities in the Emergency Department. For this reason, on the assumption that it would be meaningful to treat pneumothorax patients as outpatients by utilizing small-caliber catheters and Heimlich valve insertions, we examined the effects of such treatment and compared it with the results for patients treated with a closed thoracostomy. METHODS: A comparative study of the success rates, the complications, and the recurrence rates was done by comparing the results obtained by applying a of a small-caliber catheter and Heimlch valve insertion to the 47 spontaneous pneumothorax patients included in this study with the results for the same number of patients treated with a closed thoracostomy. After the small-caliber catheter and Heimlch valve insertion, we also examined the factors that affected success. RESULTS: The number of patients who were successfully treated for a pneumothorax by using a small-caliber catheter and a Heimlch valve insertion on the basis of ambulant care was 20 (47%), which is less than the 42 patients (89%) that were successfully treated by using a closed thoracostomy. In the follow-up assessment at six months, relapse of the pneumothorax had developed in 3 (15%) out of the 20 patients that have undergone the Heimlich valve insertion treatment and in 2 (8%) out of the 26 patients that had undergone a closed thoracostomy. While no complications developed in the group that had been treated by using a the small-caliber catheter and Heimlich valve insertion, the group treated by using a the closed thoracostomy showed the development of a hemothorax in 2 patients, subcutaneous emphysema in 7 patients, and pleural effusion in 2 patients. The medical expenses for the patients treated by using the small-caliber catheter and Heimlch valve insertion were less than these for the patient treated using a closed thoracostomy. There were no differences in age, sex, onset times, major symptoms, sizes of the pneumothorax based on the success or failure of the small-caliber catheter and Heimlich valve insertion treatment. However, all the patients that ended up with failure were found to have bleb when they underwent the operation. CONCLUSION: The success rate of ambulatory treatment with a small-caliber catheter and Heimlich valve insertion was 43%, which was lower than the value for inpaitient treatment using a closed thoracostomy. However, as there are no complications and as the medical expenses are smaller, the former treatment is thought to be of greater use in emergency treatment by physicians who are less-experienced in a closed thoracostomy and in the on-site emergency care.